PHC’s involvement in family planning

Pakistan’s population is rising at the rate of 2.4 per cent per annum and if this trend continues, the population will cross 240 million in the next 30 years. According to the population census conducted in 2017, Pakistan’s population stands at well over 207.8 million, which is almost 60 per cent more than what it was when the last census was held in 1998.

According to the Pakistan Demographic and Health Survey (2017-18), the fertility level has not shown any significant changes with women bearing an average of 3.6 children. The critical driver of fertility, the modern Contraceptive Prevalence Rate has gone down to 25 per cent from 26 per cent in 2012-13. Similarly, the unmet need for family planning services remains high at 17 per cent, an indication that millions of married couples lack access to information and services on family planning and spacing between children. Factors such as long distances, cost and social barriers and misperceptions about modern contraceptives, especially in rural areas, have contributed in the rise of unmet needs for family planning.

As defined by the World Health Organization, family planning allows individuals and couples to

1. Anticipate unwanted birth

2. Regulate interval between pregnancies

3. Determine number of children

4. Control the time at which birth occur in relation to age

Couples are educated and trained upon the methods used for contraceptives. However, it is not enough to only impart training. For far reaching results, a steady and reliable supply of quality contraceptives, a strong national health system and policies supportive of family planning are also important features.

Family planning is a human rights issue and central to gender equality and women empowerment. According to the United Nations Population Fund, if all the women, from the poor regions world over, with unmet need for contraceptives coulduse modern methods an additional 36 million abortions and 76,000 maternal deaths would be prevented every year.

Pakistan ranks 150 among 189 countries in the Human Development Index (HDI, which assesses countries across life expectancy, education and per capita income. A low ranking HDI means that the state has been unable to provide enough resources for the optimal achievements of the identified indicators.

Pakistan’s female adult literacy rate is as low as 45 per cent (2015) and female participation in the labor force is still only25 per cent. These two challenges have impeded family planning initiatives. An illiterate woman, or the one withmeagre resources, is usually dependent on the male member of her family for decisions about her married life, includingthe number of children she would have.

Women have the right to decide when to have a child. This right was reinforced in the International Conference on Population and Development (ICPD) in 1994 in Cairo where 179 governments agreed that sexual and reproductive health is the foundation for economic and social development.

Approximately one fourth of Pakistan’s population lives below the national poverty line (2015-16). Poverty increases the incidence of high fertility, high childhood and maternal mortality. Approximately 60 percent of the population is facing food insecurity and malnutrition is highly prevalent, according to the UN World Food Program (WFP). WFP reports that 44 per cent of Pakistani children younger than 5 years of age are stunted and 15 per cent suffer from acute malnutrition. Therefore, as the population increases, more people become poor and face health challenges.

Cognizant of this dismal situation, the Supreme Court under the former Chief Justice of Pakistan Justice Saqib Nisar, took Suo Moto notice in Human Rights Case No. 17599 of 2018. The apex court constituted a task force to formulate recommendations to fast-track the effort to bring population growth under control. To achieve the desired result of low fertility rate and increased contraception prevalence level, the task force recommended a mechanism of making responsible all the stakeholders related to the health sector and population control programs, to work out inclusive plans to control thepopulation growth.

The Commission has the mandate under section 4(1) (i) of the PHC Act, 2010 and sub-section (1) (h) of the same, to conduct seminars, conferences and awareness campaign on the importance of providing and receiving quality healthcare services. In line with this obligation the Punjab Healthcare Commission decided to take up awareness sessions with private practitioners and private healthcare establishments on the importance of family planning and the provision of relevant services. The sessions had the representation of the population department along with other relevant stakeholders to develop guidelines.

Tentative training sessions to sensitise the General Practitioners on family planning are scheduled in the near future.

Coincidently, this year marks the 25th anniversary of the International Conference on Population and Development to review the progress made all these years. The Nairobi Summit on ICPD25, scheduled from 12 to 14 November, 2019, will offer an inclusive platform to bring together governments, UN agencies, civil society, NGOs, women’s groups, youth networks and the private sector to make global commitments to end the unfinished business of ICPD.

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